Provider Demographics
NPI:1962588681
Name:SALAZAR, REINA O (MD)
Entity type:Individual
Prefix:DR
First Name:REINA
Middle Name:O
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21300 KELLY ROAD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021
Mailing Address - Country:US
Mailing Address - Phone:586-447-4200
Mailing Address - Fax:586-447-4208
Practice Address - Street 1:23501 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1968
Practice Address - Country:US
Practice Address - Phone:586-863-5030
Practice Address - Fax:586-209-3750
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014068552080P0201X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E85474Medicare UPIN